In the healthcare industry, we have the Affordable Care Act as a healthcare reform law. President Obama enacted it and signed it into law in 2010. Since then, it has given a new spark to healthcare systems for quality care delivery using different payment reform models. ACO reporting is one such innovative process performed by all ACO organizations. Here the accountable care organization binds several species of clinicians, hospitals, and different provider types to come together under the same shade. These groups/species render standard care to patients while taking complete responsibility for the cost of care incurred for patients.
So, what attributes are successful accountable care organizations (ACOs)? Much research has been conducted to uncover the mystery. But the majority of them are lacking because they are primarily concerned with organizational attributes.
Anyhow, we have done an in-depth overview of each minor detail of ACO reporting. So, we have devised four strategies for a Medicare ACO. Without further delay, let’s have a look at these secret strategies behind ACO Medicare’s success.
- Draft ACO Leadership Venture for Clinical Excellence
Value-based reimbursement patterns for attaining the ACO reporting goals were established a long time ago. But what we are still weak at is its practical implementation in an accountable care organization. So, we must lead with a vision of value-based clinical care. This emphasis on value-based clinical care requires a fine collaboration of clinicians in ACOs. Unlike past endeavors, any commercial ACO will be representing the best clinical practices via its ACO Quality Measures Reporting. Every clinical leader and clinician will show their complete involvement to develop better cost interventions. Simultaneously, clinical excellence introduced in such a way will be transformative and valuable for both – physicians and patients.
- Design a Technical Infrastructure for your Accountable Care Organization
It is a mandatory requirement for a commercial ACO to provide healthcare to a minimum of 5,000 beneficiaries. Otherwise, they will not be eligible for an ACO participation contract that has a 3-year contract length. So, ACOs have to report their measure to get a share in the Medicare Shared Saving Program. Therefore, they must have a fully-managed infrastructure for clinical data storage. They have to conduct macroanalysis on costs in combination with quality. In other words, they need a collection of relatively comprehensive data. For instance,
- Patient-identified clinical data;
- Health social determinants information;
- Prescribing details for claims integration;
- And much more.
As ACOs have to bear the expense in their pockets, they must have to maintain best practices throughout. If they act smart while conducting diagnostic procedures for chronic diseases, they can reduce per-patient spending. We have noticed that exacerbations lead to higher cost investment on a patient. Therefore, ACOs can control it by improving diagnostic skills. By this approach, they will be able to compare the treatment modalities and hence the costs by identifying the patient’s condition on time. And, the attending providers will take them on the right track to improvement in less time and with little spending as well.
It is crucial to have a technical infrastructure that offers secure and protected patient data storage and transfer. However, security is essential, whether you develop it, purchase it, or use a combination of both.
HIPAA compliance is a must for all systems. Anyhow, it is not a replacement for a strong data infrastructure. Working with an outside provider is probably the best option unless your company has a significant budget. The good news is that even on a limited budget, you can get inexpensive safe technological infrastructure services.
Additionally, you can find some outsourcing companies for convenient access to patient information for providers. They can even facilitate you with reliable apps including all analytics, patient episodes of care (or another cost engine), quality monitoring, and population health information.
- Supercharge Your ACO Reporting with Multidimensional Improvement Programs
Another way for successful ACO reporting could be a comprehensive understanding of increasing costs at a granular level. One must make a helpful plan to cope with the largest issues, causing financial risks to ACOs. The planning must be multidimensional enough to handle patient-risk factors, symptoms, and their results simultaneously. However, it must give preference to at-risk patients the most.
- Improve your Quality Scores through Evidence-based Measurement
There is a common misconception among quality measurements and ACO Quality Measures Reporting. Here, we must give considerable attention to quality measurements.
ACOs’ patient improvement outcomes and cost over time generate according to quality measurements. Episode-level cost and quality comparisons will uncover chances to increase savings because the process is ongoing and dynamic. Interventions and improvement efforts should start with quality measurement.
On the other side, regulatory requirements call for quality reporting. It involves a collection of static quality metrics that are examined annually for a sample of patients. Beyond filling up care gaps, the measurements don’t help you target optimal practices.
You will compete in your ACO reporting if do following in the place:
- track patient progress over time
- recognize healthcare professionals (who have embraced best practices)
- put clinical and administrative measures (that enhance patient outcomes)
ACOs generally receive their funding from the Medicare Shared Savings Program. But it is not the only program that gets the base funds from the Shared Savings Program. Coastal Medical also shares the same funding base. Moreover, ACO Investment Model (AIM) and similarly, the Next Generation Accountable Care Organization (NGACO) model have exposed ACOs to more financial risks. It seems that different value-based payment models are competing with ACOs. This can influence the ACOs in attracting more physicians and patients. So, it’s better to adopt the above-mentioned strategies for ACO reporting today. And secure the value for your organization and patients.